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Understanding the RUC
Survey Instrument
Understanding the RUC Survey
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Survey basics
Purpose of the survey
Who does what?
Breaking down the survey into 7 easy
steps
• Still have questions?
• What happens next?
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Why are the surveys being
conducted?
• Your societies need your help to assure
relative values will be accurately and fairly
presented to the Centers for Medicare and
Medicaid Services during this revision
process.
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When are responses due?
• Please submit your response by the date
provided in the e-mail you receive
• The timeliness of your response is critical
because data will need to be analyzed
before it can be submitted to the RUC.
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Purpose of the survey
• To obtain estimates of the time and
complexity required in performing a
procedure
• To obtain estimate of a recommended
professional work value
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How the survey works
• The survey asks you to compare the time,
complexity and work to perform the
surveyed procedures to an existing
procedure
• A list of possible reference procedures is
provided for comparison purposes
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Who does what?
AMA/Specialty Society RVS Update Committee
(RUC)
•Oversees survey process of codes
•Recommends physician work & practice expense
values to Centers for Medicare & Medicaid
Services (CMS)
Societies/Associations
•Coordinate process for respective professions
•Distribute work surveys to members to obtain
work & practice expense data
•Submit survey results to AMA RUC
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Who does what?
• Specialty societies submit
recommendations to the RUC for
physician work, practice expense inputs
and professional liability insurance
crosswalks
• Recommendations are presented at the
RUC meetings which occur three times a
year
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Who does what?
• The RUC sends its recommendations for
work values, practice expense inputs and
PLI crosswalks to CMS in May which are
confidential until the CMS publication of
the Final Rule in November.
• Values go into effect in January of the
following year.
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Partitioning the survey into 7 easy
steps
• STEP 1 – Review code descriptor and vignette
(a short description of the patient)
• STEP 2 – Review introduction & complete
contact information
• STEP 3 – Identify a reference procedure
• STEP 4 – Estimate your time
• STEP 5 – Compare the survey procedure to a
reference procedure
• STEP 6 – Moderate Sedation
• STEP 7 – Estimate work RVU (relative value
unit)
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STEP 1:
Review code descriptor & vignette
• The vignette describes a TYPICAL clinical
scenario for the procedure
• You may have performed the procedure
on a patient different than the ‘typical’ one
described in the vignette – that’s okay.
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STEP 1 continued
• Complete the survey instrument using the
typical patient described by your society.
• The survey instrument allows for you to
inform them that you do not believe the
typical patient as defined is typical.
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STEP 2
Review introduction & complete contact
information
• Although contact and basic practice
information is collected, your name is
never forwarded to the AMA or used for
tracking purposes.
• If you have any questions, a specialty
society’s contact information will be
provided
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STEP 3:
Identify a reference procedure
• List of reference codes – the survey includes a
list of procedures that have been selected for
use as comparison for this survey because their
relative values are sufficiently accurate and
stable to compare with other services. Select a
procedure from the list that is most similar in
time and work to the new/revised CPT code
descriptor and typical patient/service described.
• Reference procedure does not have to be equal
in work in your judgment to the surveyed
procedure but it should be similar in work
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STEP 3:
Identify a reference procedure
• It is very important to consider the global period
when you are comparing the new/revised code to
the reference code
• A service paid on a global basis includes:
– Visits and other physician services provided within 24
hours prior to the service
– Provision of the service
– Visits and other physician services for a specified number
of days after the service is provided (000 day global = 0
days of post care included in the work RVU, 090 day
global = 90 days of post care included in the work RVU)
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STEP 4: Estimate your time
• Using the vignette and the description of
service periods, this section of the survey
asks you to estimate how much time it
takes you when you perform the
procedure. These estimates should be
based on personal experience.
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Pre-service period defined
• The pre-service period includes physician
services provided from the day before the
operative procedure until the time of the
operative procedure
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Pre-service period defined
• The pre-service period may include the following:
– Hospital Admission Work-Up
– Pre-Operative Evaluation
– Dressing, Scrubbing, Waiting and Positioning the
Patient
• The pre-service period does not include:
– Consultation or evaluation at which the decision to
provide the procedure was made
– Distinct evaluation and management services
provided in addition to the procedure
– Mandated services
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Intra-service period defined
• The intra-service period includes all “skin
to skin” work that is a necessary part of
the procedure
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Post-service period defined
• Post service period includes physician
services provided on the day of the
procedure after the procedure has been
performed
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Post-service period defined
• The post-service period may include:
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Post-operative care on day of procedure
Non skin-to-skin work in the OR
Patient stabilization in the recovery room or special unit
Communicating with the patient and other professionals
Patient visits on the day of the operative procedure
• The post-service period does not include:
– Unrelated evaluation and management services provided during
the post-operative period
– Return to the operating room for a related procedure during the
post-operative period
– Unrelated procedure or service performed by the same physician
during the post-operative period
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STEP 5
Compare the procedure to a reference
procedure – intensity/complexity
• In this step you will be asked to compare
the complexity and intensity of the
procedure being surveyed with the
reference procedure
• In evaluating the work of a service, it is
helpful to identify and think about each of
the components of a particular service.
Focus only on the work that you perform
during each of the identified components.
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Definitions
• Physician work includes the following elements:
– The time it takes you to perform the service
– The mental effort and judgment necessary with
respect to the amount of clinical data that needs to be
considered, the fund of knowledge required, the
range of possible decisions, the number of factors
considered in making a decision and the degree of
complexity of the interaction of these factors
– The technical skill required with respect to
knowledge, training and actual experience necessary
to perform the service
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Definitions continued…
• The physical effort required to perform the
procedure.
• Physical effort can be compared by dividing
services into tasks and making direct
comparisons of tasks. In making the
comparison, it is necessary to show that the
differences in physical effort are not just
reflected accurately by differences in the time
involved; if they are considerations of physical
effort amount to double counting of physician
work in the service
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Definitions continued…
• Your psychological stress
• Two kinds of psychological stress are usually associated
with physician work. The first is the pressure involved
when the outcome is heavily dependent upon skill and
judgment and an adverse outcome has serious
consequences. The second is related to unpleasant
conditions connected with the work that are not affected
by skill or judgment. These circumstances would include
situations with high rates of mortality or morbidity
regardless of the physician’s skill or judgment, difficult
patients or families, or physician physical discomfort.
The first type is the only form of stress accepted as an
aspect of work
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Definitions continued…
• Physician work does not include services
provided by support staff who are
employed by your practice and cannot bill
separately including:
– Registered Nurses,
– Licensed Practical Nurses,
– Medical Secretaries,
– Receptionists and
– Technicians
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STEP 6
Moderate sedation
• Moderate sedation is a service provided by the operating
physician or under the direct supervision of the physician
performing the procedure to allow for sedation of the
patient with or without analgesia through administration
of medications via the intravenous, intramuscular,
inhalational, oral, rectal or intranasal routes. For
purposes in the RUC survey, sedation and analgesia
delivered separately by an anesthesiologist not
performing the primary procedure is not considered
moderate sedation.
• Is moderate sedation provided in the surveyed and/or
reference code and in what setting (Facility/NonFacility)?
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STEP 7 Estimate work RVU
VERY IMPORTANT
• In this final step you will be asked to estimate
the work relative value unit (RVU)
• You are asked to consider the value assigned to
the reference procedure in developing your
estimate
• The survey methodology attempts to set the
work RVU of the procedure “relative” to the work
RVU of the comparable and established
reference procedure
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